| NPI | 1578659710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD035953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 26841) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101246402) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP812) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-05-02 |